Removal Of Pituitary Tumor Research Articles

Advances in Skull Base Reconstruction After Transnasal Endoscopy

Endoscopic transnasal approach have experienced rapid development and gradual maturation in just a few decades (Kassam AB, Prevedello DM, Carrau RL, et al, 2011; Eloy J A, Vivero R J, Hoang K, et al, 2009). It has expanded from the removal of conventional pituitary tumours to the application of an endoscopic extended transsphenoidal approach for the resection of tumours in the intrasellar, suprasellar and even ventricular systems (Cappabianca P, Cavallo L M, Esposito F, et al, 2008). Larger bone and dural defects at the skull base, causing more severe postoperative complications and resulting in a multiplication of the healthcare burden (Eloy J A, Shukla P A, Choudhry O J, et al, 2013). Skull base Reconstruction after tumour removal has become a great challenge. Currently, skull base reconstruction is mainly divided into soft and rigid reconstruction, and soft reconstruction is represented by the technique of pedicled nasal septum mucosal flap (PNSF) (Thorp B D, Sreenath S B, Ebert C S, et al, 2014)0. As for rigid reconstruction, it is still controversial (Shin J, Forbes J, Lehner K, et al, 2019; Eloy J A, Shukla P A, Choudhry O J, et al, 2012). From the current studies, rigid reconstruction has a role that cannot be ignored. In this article, we will describe the development of skull base surgery and several high-profile skull base reconstruction techniques.

A methodology for the annotation of surgical videos for supervised machine learning applications.

Surgical data science is an emerging field focused on quantitative analysis of pre-, intra-, and postoperative patient data (Maier-Hein et al. in Med Image Anal 76: 102306, 2022). Data science approaches can decompose complex procedures, train surgical novices, assess outcomes of actions, and create predictive models of surgical outcomes (Marcus et al. in Pituitary 24: 839-853, 2021; Røadsch et al. in Nat Mach Intell, 2022). Surgical videos containpowerful signals of events that may impact patient outcomes. Anecessary stepbefore the deployment of supervised machine learning methodsis the development of labels for objects andanatomy. We describe a complete method for annotating videos of transsphenoidal surgery. Endoscopic video recordings of transsphenoidal pituitary tumor removal surgeries were collected from a multicenter research collaborative. These videos were anonymized and stored in a cloud-based platform. Videos were uploaded to an online annotation platform. Annotation framework was developed based on a literature review and surgicalobservations to ensure proper understanding of the tools, anatomy, and steps present. A user guide was developed to trained annotators to ensure standardization. A fully annotated video of a transsphenoidal pituitary tumor removal surgery was produced. This annotated video included over 129,826 frames. To prevent any missing annotations, all frames were later reviewed by highly experienced annotators and a surgeon reviewer. Iterations to annotated videos allowed for the creation of an annotated video complete with labeled surgical tools, anatomy, and phases. In addition, a user guide was developed for the training of novice annotators, whichprovides information about the annotation software to ensure the production of standardized annotations. A standardized and reproducible workflow for managing surgical video data is a necessary prerequisite to surgical data science applications. We developed a standard methodology for annotatingsurgical videos that mayfacilitate the quantitative analysis of videos using machine learning applications. Future work will demonstrate the clinical relevance and impact of this workflow by developingprocess modeling andoutcome predictors.

Optical coherence tomography detects early optic nerve damage before visual field defect in patients with pituitary tumors.

Optical coherence tomography (OCT) is a useful tool for predicting visual recovery after the removal of pituitary tumors. However, the utility of OCT in patients with pituitary tumors and a normal visual field is unclear. We aimed to analyze OCT features in pituitary tumors without visual field defects. Pituitary tumors without visual field defects were selected. A total of 138 eyes from 69 patients, assessed by the Humphrey visual field test and OCT, were enrolled in this study. Using preoperative coronal sections of MR images, patients were divided into chiasmal compression (CC) and non-chiasmal compression (non-CC) groups, and OCT characteristics were examined. The CC and non-CC groups consisted of 40 and 29 patients, respectively. There were no differences in age, sex, tumor type, or degree of visual field testing, but the tumor size was different between the two groups. On OCT, macular thickness ganglion cell complex (mGCC) was significantly thinner in the CC group than that in the non-CC group (112.5 vs 117.4 um, P < 0.05). Based on a database of healthy participants, 24% and 2% of eyes in the CC and non-CC groups had abnormal mGCC thickness (P < 0.01), respectively. In a sub-analysis of the CC group, patients with an abnormal mGCC thickness were older than a normal one (58.2 vs 41.1years, p < 0.01). OCT can detect early optic nerve damage due to optic CC by pituitary tumors, even in normal visual fields. The degree of mGCC thinning may provide an appropriate surgical timing for pituitary tumors that compress the optic chiasm.

Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study

Abstract Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg/kg, followed by 0.2 mcg/kg/h, and to group II at the same loading dose, followed by 0.5 mcg/kg/h. Comparative analyses were performed using the Student's t-test, repeated-measures analysis of variance, and Mann–Whitney U test; p-values &lt; 0.05 were considered statistically significant. Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension (p = 0.034). Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg/kg/h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.

ODP293 Aberant Expression of SF-1 Transcription Factor in ACTH-secreting Pituitary Tumors: Possible Association With Aggressive Disease Evolution

Abstract Cushing's disease represents a rare endocrine disorder caused by hypercortisolism due to an ACTH-secreting pituitary tumor. Pituitary adenomas (PAs) are mostly benign tumors but may have features of invasiveness and aggressiveness. They are clinically classified by their hormone-secreting characteristics. Expression of pituitary hormones in adenohypophyseal cells is controlled by several transcription factors (PIT1 for GH, PRL and TSH lineage, SF1 for gonadotroph lineage and TPIT for ACTH lineage). Eight cases of Cushing's disease (CD) were included in the current study. The diagnostic was sustained by clinical features, hormonal assessment, and radiological findings (pituitary CT or MRI). All patients underwent surgical removal of pituitary tumor using transsphenoidal resection. All tissue specimens were evaluated using histological routine staining (hematoxylin and eosin) and immunohistochemical staining for vimentin, pituitary hormones (GH, PRL, TSH, FSH, LH, ACTH), and transcription factors (PIT1, TPIT, SF1). The intensity IHC scores ranged from 0 to 3+ and a staining higher than 30% (2+) was considered positive for interpreting the results. Based on the histopathological and immunohistochemical data correlated with the evolution of the disease (remission versus persistent disease), five molecular subgroups were identified. Subgroups 1 to 3 had a positive expression of ACTH and TPIT, with variations regarding SF1 expression: there was no expression in subgroup 1, nuclear positivity in 2, and cytoplasmic reaction in 3. Subgroups 4 and 5 consisted of plurihormonal adenomas with unusual immunohistochemical combination. They had IHC positive score for ACTH, GH, TPIT and were differentiated by the expression of SF1: lack of expression in subgroup 4 and intense cytoplasmic reaction in 5. The expression of SF1 was linked to the evolution of the disease, patients from subgroups which did not have SF1 cytoplasmic reaction (1, 2, 4) had remission of CD, while patients in subgroups 3 and 5 had persistent disease (including one case who evolved to exitus due to cardiovascular complications of the severe hypercortisolism). Transcription factors evaluation is important for classifying pituitary adenomas and finding clinicopathological correlations with the aim of providing a better therapeutical approach. In the current study, although SF1 is a marker of gonadotroph lineage (1), its aberrant cytoplasmic expression in CD may contribute to an aggressive evolution and to other cell lineage differentiation (PIT1, TPIT). Neou M et al, Pangenomic Classification of Pituitary Neuroendocrine Tumors. Cancer Cell. 2020 Jan 13;37(1): 123-134. e5. doi: 10.1016/j. ccell.2019.11. 002. Epub 2019 Dec 26. PMID: 31883967. Presentation: No date and time listed

Outcomes and surgical nuances in management of giant pituitary adenomas: a review of 108 cases in the endoscopic era.

Giant (maximum diameter ≥ 4 cm) pituitary macroadenomas are complex tumors that require resection for decompression of optic nerves, relief of mass effect, and symptom improvement. Given the lack of surgical accessibility, the lateral extent of the lesions, and the invasion of the cavernous sinus, management presents a significant challenge. Transsphenoidal, transcranial, and combined approaches have been viable options for resection. The authors present their findings from a large series of patients to characterize giant pituitary adenomas, document outcomes, and outline surgical nuances in resection of these tumors. The authors reviewed 887 consecutive patients who underwent resection of pituitary adenomas at a single institution. From this group, 108 patients with giant pituitary adenomas who underwent resection between January 1, 2002, and December 31, 2020, were identified for inclusion in the study. The patient demographics, clinical presentation, tumor imaging characteristics, surgical approaches, and postoperative outcomes were analyzed using descriptive statistics. The mean preoperative tumor diameter in this cohort was 4.6 ± 0.8 cm, with a mean volume of 25.9 ± 19.2 cm3. Ninety-seven patients underwent transsphenoidal approaches only, 3 underwent transcranial resection, and 8 patients underwent a combined approach. Gross-total resection was achieved in 42 patients. Tumor stability without a need for additional therapy was achieved in 77 patients, with 26 patients undergoing subsequent adjuvant radiotherapy. Among 100 patients with sufficient follow-up, 14 underwent adjuvant therapy-repeat operation and/or adjuvant radiation therapy-because of recurrence or tumor progression. Six patients with recurrence were observed without additional treatment. Overall, the morbidity associated with removal of these lesions was 11.1%; the most common morbidities were cerebrospinal fluid leak (5 patients, 4.6%) and hydrocephalus (4 patients, 3.7%). One death due to postoperative pituitary apoplexy of the residual tumor and malignant cerebral edema occurred in this cohort. Giant pituitary tumors still represent a surgical challenge, with significant morbidity. Gross-total resection occurs in a minority of patients. Surgical goals for removal of giant pituitary tumors should include attempts at removal of most tumor tissue to minimize the risk of residual tumor apoplexy by tailoring the approach along the major axis of the tumor. Experience with both transsphenoidal and multiple transcranial techniques is necessary for minimizing complications and improving outcomes.

Endoscopic transsphenoidal surgery for resection of pituitary macroadenoma: A retrospective study.

BackgroundThe endoscopic transsphenoidal approach is an efficient minimally invasive procedure for removal of pituitary tumors that can be accomplished through a one-hand or two-hand approach. The one-hand procedure through one nostril is more intuitive for surgeons, but maneuvering the instruments can be restrictive. The two-hand procedure using a one-and-half nostril approach provides more precise manipulation. This study aimed to compare the surgical outcomes of one-hand/mono-nostril and two-hand/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon.Materials and methodsThe surgical data of 78 consecutive cases with pituitary macroadenoma (diameter >1 cm) were reviewed retrospectively. Altogether, 30 cases received one-hand/mono-nostril surgery, while 48 cases received two-hand/one-and-half nostril surgery. Postoperative outcomes of the two operations were compared.ResultsThe operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand/one-and-half nostril surgery group compared with that in the one-hand/mono-nostril surgery group (all p>0.05). However, postoperative hypopituitarism was less frequent (1/48; 2.0%) with the two-hand/one-and-half nostril approach than with the mono-nostril approach (p = 0.004). Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (p = 0.044).ConclusionA single-surgeon endoscopic endonasal transsphenoidal surgery with two-hand/one-and-half nostril approach is an effective and safe procedure for removal of large pituitary tumors.

Collaborative Robotic Assistant Platform for Endonasal Surgery: Preliminary In-Vitro Trials.

Endonasal surgery is a minimally invasive approach for the removal of pituitary tumors (sarcomas). In this type of procedure, the surgeon has to complete the surgical maneuvers for sarcoma resection with extreme precision, as there are many vital structures in this area. Therefore, the use of robots for this type of intervention could increase the success of the intervention by providing accurate movements. Research has focused on the development of teleoperated robots to handle a surgical instrument, including the use of virtual fixtures to delimit the working area. This paper aims to go a step further with a platform that includes a teleoperated robot and an autonomous robot dedicated to secondary tasks. In this way, the aim is to reduce the surgeon’s workload so that he can concentrate on his main task. Thus, the article focuses on the description and implementation of a navigator that coordinates both robots via a force/position control. Finally, both the navigation and control scheme were validated by in-vitro tests.

Pituitary Surgery: Changing the Paradigm in Veterinary Medicine in the United States.

Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical management does not provide a cure for either disease process, and rarely is pituitary imaging a part of initial diagnostics. Early pituitary imaging in animals with clinically functional pituitary tumors provides a baseline assessment, allows monitoring of tumor changes, and permits radiation and surgical planning. Surgery is the only treatment for pituitary tumors that has curative intent and allows for a definitive diagnosis. Surgical removal of pituitary tumors via transsphenoidal hypophysectomy is an effective treatment for clinical pituitary tumors in patients exhibiting endocrine abnormalities associated with pituitary-dependent hyperadrenocorticism and hypersomatotropism. Surgery, however, is rarely pursued until patients have failed medical management, and often not until they are showing neurologic signs, making surgical success challenging. It is well documented that dogs surgically treated when the pituitary mass is small have a lower mortality, a lower recurrence rate, and a longer survival than those with larger pituitary masses. Providing owners with the option of early pituitary imaging in addition to medical, surgical, and radiation treatment options should be the standard of care for animals diagnosed with pituitary-dependent hyperadrenocorticism or hypersomatotropism.

Pituitary metastasis of lung carcinoma presenting as diabetes insipidus: Case report

Metastasis to Pituitary gland is an extremely rare condition. Patients are usually asymptomatic and imaging studies often miss the lesion. Pituitary metastases so far reported are largely from autopsies done for unrelated reasons. Here, we describe a case of pituitary metastasis, presented with diabetes insipidis, underwent surgery for removal of pituitary tumor and diagnosed as metastatic lung cancer using immunohistochemical studies.

SAT-616 Coexistence of Resistance to Thyroid Hormone Syndrome and Pituitary Granular Cell Tumor in a Taiwanese Young Lady Mimicking TSH Secreting Tumor

Background Resistance to thyroid hormone (RTH) syndrome is a rare disorder which presents as high free thyroid hormones with unsuppressed thyroid-stimulating hormone (TSH) secretion and diminished responsiveness to thyroid hormones by target organ. Appropriate diagnosis is crucial to avoid over-treatment with anti-thyroid drugs, radio-iodine ablation, and/or pituitary surgery. The aim of this report was to present the first case of RTH in Taiwan, who was misdiagnosed as TSH secreting tumor but later proved to have pituitary granular cell tumor instead. Clinical case A 33-year-old Taiwanese married woman was found to have elevated free T4: 3.92 ng/dL (normal: 0.8-1.9) and TSH: 5.82 μIU/mL (normal: 0.4-4.0) levels on pre-natal counseling for evaluation of palpitation and difficult conception in 2013. Besides mild tachycardia (heart rate: 98 beats per minute), she had no other symptoms and signs of hyperthyroidism. Propylthiouricil was prescribed by her gynecologist and discontinued one year later due to persistence of abnormal thyroid hormone levels under medication. Afterwards, she was referred to an endocrinologist and was told to have central hyperthyroidism based on negative thyroid autoantibodies, moderately enlarged homogenous thyroid glands on thyroid sonography, and a 1.2 cm right pituitary adenoma on sella magnetic resonance imaging (MRI). Endoscopic trans-phenoidal surgery for pituitary tumor removal was performed in May, 2017. Histopathology revealed granular cell tumors that were positive for S-100 protein and TTF-1 but negative for TSH, ACTH, GH and prolactin on immunohistochemical staining. In February 2018, she visited Taipei Veterans General Hospital due to persistence of abnormal thyroid hormone levels (free T4: 2.19 ng/dL; T3: 209 ng/dL, normal: 58-159; total T4 14.78 ug/dl, normal: 4.5-12.50; TSH 3.75 μIU/mL) after pituitary surgery. Post-operative sella MRI showed no residual pituitary tumor. After administration of 200 mcg of thyrotropin releasing hormone (TRH) intravenously, exaggerated TSH response was noted, with TSH levels showing 6.0, 24.7, 22.6, and 14.7 μIU/mL at 0, 20, 30, and 60 minutes, respectively, leading to the diagnosis of RTH. DNA sequencing of exons 4-10 of thyroid hormone receptor β gene revealed no mutation. As pregnancy was planned, Inderal 5mg thrice daily was used to lower T3 levels in case if a non-RTH fetus exists. Clinical lessons Although rare, RTH should be considered in the differential diagnosis of high thyroid hormone levels with unsuppressed TSH. The presence of a pituitary adenoma does not conclude a TSH secreting tumor, like our case. We suggest careful evaluation with functional and genetic testing prior to initiation of therapy in order to avoid unnecessary surgeries and medications. A favorable outcome generally follows a diagnosis of RTH. Special consideration needs to be taken in mothers with RTH harboring wild-type fetus.

Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors.

For the precise removal of pituitary tumors, preserving the surrounding normal structures, we need real-time intraoperative information on tumor location, margins, and surrounding structures. The aim of this study was to evaluate the benefits of a new intraoperative real-time imaging modality using indocyanine green (ICG) fluorescence through an endoscopic system during transsphenoidal surgery (TSS) for pituitary tumors. Between August 2013 and October 2014, 20 patients with pituitary and parasellar region tumors underwent TSS using the ICG fluorescence endoscopic system. We used a peripheral vein bolus dose of 6.25mg/injection of ICG, started with a time counter, and examined how each tissue type increased and decreased in fluorescence through time. A total of 33 investigations were performed for 20 patients: 9 had growth hormone secreting adenomas, 6 non-functioning pituitary adenomas, 3 Rathke's cleft cysts, 1 meningioma, and 1 pituicytoma. After the injection of ICG, the intensity of fluorescence of tumor and normal tissues under near-infrared light showed clear differences. We could differentiate tumor margins from adjacent normal tissues and define clearly the surrounding normal structures using the different fluorescent intensities time changes and tissue-specific fluorescence patterns. The ICG endoscopic system is simple, user-friendly, quick, cost-effective, and reliable. The method offered real-time information during TSS to delimit pituitary and parasellar region tumor tissue from surrounding normal structures. This method can contribute to the improvement of total removal rates of tumors, reduction of complications after TSS, saving surgical time, and preserving endocrinological functions.

Use of intraoperative intracavitary (direct-contact) ultrasound for resection control in transsphenoidal surgery for pituitary tumors: evaluation of a microsurgical series

Perisellar infiltration may be responsible for incomplete removal of pituitary tumors. Since intraoperative visualization of parasellar structures is difficult during transsphenoidal surgery, we are describing the use of intraoperative direct contact ultrasound (IOUS). Within 5years, in 113 transsphenoidal operations (58 male, 55 female, age 14-81years, 110 pituitary adenomas (mean diameter 26.6mm, 69 non-secreting adenomas, 41 secreting adenomas), and 1 of each Rathke's cleft cyst, craniopharyngioma, and xanthogranuloma), IOUS was applied. After wide opening of the sellar floor and removal of the intrasellar tumor portions, a commercially available side fire ultrasound probe is introduced, and in direct contact to the sellar envelope, the perisellar space is scanned perpendicular to the axis of the working channel. We compared the results of IOUS to postoperative MRI after 3-6months. Identification of the intracavernous ICA, the anterior optic pathway, and the ACA, was possible, it was safe to operate close to them. In 65 operations (58%), further resection of tumor remnants was performed after IOUS. In this selected series, complete resection of tumors (stated by postoperative MRI after 3-6months) was achieved in 75 operations (66%) and remission was achieved in 18 operations of secreting adenomas (44%). Compared to MRI after 3 to 6months, the sensitivity of IOUS was 0.568 and the specificity was 0.907. No complications related to IOUS were seen. Visualization of the perisellar compartments by IOUS is easy and fast to perform. It allows the surgeon to identify resectable tumor remnants intraoperatively, which otherwise could be missed.

Predictive Factors for Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery in Patients with Nonfunctioning Pituitary Tumors: A Retrospective Observational Study

Delayed hyponatremia can occur after transsphenoidal pituitary tumor surgery, resulting in unexpected readmission. Predictive factors for delayed hyponatremia after this type of surgery are not well established. In this retrospective study, predictive factors for delayed hyponatremia were investigated in patients undergoing transsphenoidal pituitary tumor surgery. Preoperative data (demographics, comorbidities, and hormonal assessment), preoperative, intraoperative, and immediate postoperative sodium concentrations, the nadir sodium concentration on postoperative day (POD) 1-2, characteristics of pituitary tumor (size, cell type, optic chiasm compression, and cavernous sinus invasion), and intraoperative data (operation time and fluid balance) were retrospectively collected from 234 patients undergoing endoscopic transsphenoidal surgery for removal of nonfunctioning pituitary tumors. Delayed hyponatremia was defined as serum sodium concentration <135 mEq/L on POD 3 or later, and after discharge, postoperative sodium concentration was measured on POD 7-10. Delayed hyponatremia was observed in 53 patients (22.6%). Of these patients, 5 (9.4%) were readmitted because of delayed hyponatremia. In binary logistic regression analysis, age >60 years (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.16-4.26; P= 0.017), the nadir sodium concentration on POD 1-2 (OR, 0.88; 95% CI, 0.77-0.99; P= 0.034), and operation time (OR, 1.01; 95% CI, 1.00-1.02; P= 0.018) were independent risk factors for delayed hyponatremia after endoscopic transsphenoidal pituitary surgery. The incidence of delayed hyponatremia in patients with nonfunctioning pituitary tumor who underwent endoscopic transsphenoidal surgery was 22.6%. Old age, low sodium concentration on POD 1-2, and long operation time were associated with the development of delayed hyponatremia in such patients.

Features of anesthesiological management for transnasal surgical in pituitary adenomas: literature review

Tumors of the pituitary gland make up about 10% of all neoplasms of the brain, mainly represented by adenomas. A feature of a larger number of adenomas is the symptoms of hypersecretion of the pituitary hormones, which leads to typical changes in the patient’s body. Surgical removal of pituitary tumors is performed through endoscopical transnasal access. Understanding the individualities of patients, the disease course and the operation course helps the anesthesiologist to ensure adequate preoperative preparation, anesthesia and postoperative management for patients, which reduces the number of complications and facilitates the early recovery of patients.

Erratum to: Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s.

The field of pituitary surgery was born in the first decade of the twentieth century in Europe, and it evolved rapidly with the development of numerous innovative surgical techniques by some of the founding fathers of neurosurgery. This study investigates the pioneering Italian treatise on pituitary surgery, La Patologia Chirurgica dell’Ipofisi (Surgical Pathology of the Hypophysis), published in 1911 by Giovanni Verga (1879–1923), a surgeon from Pavia and one of Golgi’s disciples. This little-known monograph compiles the earliest experience on pituitary surgery through the analysis of the first 50 procedures performed between 1903 and 1911. We conducted a biographical survey of Giovanni Verga and the motivations for his work on pituitary surgery. In addition, a systematic analysis of all original reports and historical documents about these pituitary procedures referenced in Verga’s treatise was carried out. Verga’s treatise provides a summary of the techniques employed and surgical outcomes for the first 50 attempted procedures of pituitary tumor removal. This monograph is the only scientific source that includes a complete account of the series of 10 pituitary tumors operated on by Sir Victor Horsley in the 1900s. Three major types of surgery were employed: (i) palliative procedures of craniectomy (n = 6); (ii) transcranial approaches to the pituitary gland, either subfrontal or subtemporal (n = 13); and (iii) transphenoidal routes to expose the sella turcica, either using an upper transnasal-transethmoidal approach (n = 19) or a lower sublabial/endonasal-transeptal one (n = 12). An operative mortality rate of 36% (n = 17) was observed in these early series. The pathological nature of the tumors operated on was available in 42 cases. There were 28 adenomas and 15 craniopharyngiomas. Sir Victor Horsley (1857–1916) and the Viennese surgeons Anton von Eiselsberg (1860–1939) and Oskar Hirsch (1877–1965) were the leading European figures in the development of pituitary surgery. Giovanni Verga’s treatise La Patologia Chirurgica dell’Ipofisi is a fundamental, pioneering book in the history of pituitary surgery, a work that compiles the foundations of this field in Europe and the only authoritative source providing a complete record of pituitary procedures performed by Sir Victor Horsley.

Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s.

The field of pituitary surgery was born in the first decade of the twentieth century in Europe, and it evolved rapidly with the development of numerous innovative surgical techniques by some of the founding fathers of neurosurgery. This study investigates the pioneering Italian treatise on pituitary surgery, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), published in 1911 by Giovanni Verga (1879-1923), a surgeon from Pavía and one of Golgi's disciples. This little-known monograph compiles the earliest experience on pituitary surgery through the analysis of the first 50 procedures performed between 1903 and 1911. We conducted a biographical survey of Giovanni Verga and the motivations for his work on pituitary surgery. In addition, a systematic analysis of all original reports and historical documents about these pituitary procedures referenced in Verga's treatise was carried out. Verga's treatise provides a summary of the techniques employed and surgical outcomes for the first 50 attempted procedures of pituitary tumor removal. This monograph is the only scientific source that includes a complete account of the series of 10 pituitary tumors operated on by Sir Victor Horsley in the 1900s. Three major types of surgery were employed: (i) palliative procedures of craniectomy (n=6); (ii) transcranial approaches to the pituitary gland, either subfrontal or subtemporal (n=13); and (iii) transphenoidal routes to expose the sella turcica, either using an upper transnasal-transethmoidal approach (n=19) or a lower sublabial/endonasal-transeptal one (n=12). An operative mortality rate of 36% (n=17) was observed in these early series. The pathological nature of the tumors operated on was available in 42 cases. There were 28 adenomas and 15 craniopharyngiomas. Sir Victor Horsley (1857-1916) and the Viennese surgeons Anton von Eiselsberg (1860-1939) and Oskar Hirsch (1877-1965) were the leading European figures in the development of pituitary surgery. Giovanni Verga's treatise La Patologia Chirurgica dell'Ipofisi is a fundamental, pioneering book in the history of pituitary surgery, a work that compiles the foundations of this field in Europe and the only authoritative source providing a complete record of pituitary procedures performed by Sir Victor Horsley.

Endoscopic endonasal trans-sphenoidal approach for pituitary fossa tumor: Outcome analysis of 39 consecutive procedures

BackgroundTo assess postoperative rhinological complaints, length of hospital stay and complications related to endoscopic, endonasal trans-sphenoidal procedures. Patients and methodsFrom May 2001 through May 2007, a retrospective analysis was conducted on a series of 39 patients that underwent endonasal surgery and 9 patients that had craniotomy removal of pituitary tumors. Questionnaires were filled out at both 2 weeks and 3 months after surgery, most of which were completed in the outpatient department if the patient was discharged. Nasal packing lasted for 72 h in 29 patients, but not in the last 10 patients. ResultsOf the 12 patients with preoperative headache, 50% had complete resolution, 33% had partial resolution and 17% reported no change. The frequency of rhinological complaints declined between the two questionnaires (p < .001). After 3 months, 64–84% of patients had no rhinological complaints, while 2.5% had severe complaints. Of the 9 patients with complications, rhinological complaint severity was similar to those without complications (p < .001). ConclusionsThe direct endonasal trans-sphenoidal approach for pituitary fossa tumor is associated with a rapid rhinological recovery, shorter hospital stay and a low occurrence of serious long-term sinonasal complaints.

An experimental feasibility study on robotic endonasal telesurgery.

Novel robots have recently been developed specifically for endonasal surgery. They can deliver several thin, tentacle-like surgical instruments through a single nostril. Among the many potential advantages of such a robotic system is the prospect of telesurgery over long distances. To describe a phantom pituitary tumor removal done by a surgeon in Nashville, Tennessee, controlling a robot located approximately 800 km away in Chapel Hill, North Carolina, the first remote telesurgery experiment involving tentacle-like concentric tube manipulators. A phantom pituitary tumor removal experiment was conducted twice, once locally and once remotely, with the robotic system. Robot commands and video were transmitted across the Internet. The latency of the system was evaluated quantitatively in both local and remote cases to determine the effect of the 800-km distance between the surgeon and robot. We measured a control and video latency of < 100 milliseconds in the remote case. Qualitatively, the surgeon was able to carry out the experiment easily and observed no discernable difference between the remote and local cases. Telesurgery over long distances is feasible with this robotic system. In the longer term, this may enable expert skull base surgeons to help many more patients by performing surgeries remotely over long distances.

脳外科用レーザーパルスジェットメスハンドピースの使用感向上設計と評価に関する研究

As a new surgical device to accomplish both maximum tumor removal and functional preservation, Laser Induced Liquid Jet (LILJ) has been developed. Since 2011, the multicenter clinical trial has commenced intended pituitary tumor removal in 7 hospitals, all of whom were assigned to high volume center of pituitary tumor treatment in Japan, and they encountered over 100 cases in total. From the questionnaire filled by the surgeons, the surgeons desired the usability of LILJ hand piece to be improved. In this study, we designed and attached a new grip adapter for hand piece, and evaluated it in terms of weight center control, moment, and robustness against disturbance input in ergonomic experiments. In the results, the hand piece with the new grip adapter accomplished the reduction of the applied force by each finger from 1.4 to 0.4 mN (29%) and the error distance by mistaken fire from 19.5 to 9.1 mm (47%). Hence, the stability and operability of the LILJ hand piece were progressed.